Slightly OT--A little Nervous about colonoscopy and my SA

Ok, I'm scheduled for just a screening colonoscopy next week. (something you're supposed to do when you turn 50) I've been doing alot of reading but I must say i'm getting a little nervous.
For those who have had colonoscopies before--how uncomfortable is it really if you don't want any sedation etc?? This will be in a clinic setting (not hospital or surgical center setting) just drs. office. If I opt for sedation, I'm assuming it would be best to bring machine and mask. I guess what i'm most nervous about is that because of the OSA they might opt not to use any sedation or pain meds then i'm worried how it's going to feel and if it's really worth it to even have it done in the first place as I have no problems but a family history of breast cancer?? I can honestly say i'm not particularly fond of the whole idea but i made a promise to a dr.(not the one whos doing this but the surgeon who took out my GB in Jan) that when I turned 50 i'd have this done. I'm scared because of what happened in ER when i had my GB attack and the meds they gave me plumited my 02 levels--i don't want that happening again--however i don't want to be miserable during the proceedure either. srry for the ranting --i guess i need just a little encouragement.

I have never heard of a colonoscopy being given without sedation (and I've probably edited more than 1000 colonoscopy reports...probably more, even). If it's being done in a doctor's office, it's most likely a sigmoidoscopy (similar to colonoscopy but examines less of the colon). Those are routinely done without sedation, and most report that they are uncomfortable but tolerable.

karessamom, if you don't mind, I'm going to tag along on your thread here. I also am going to have a colonoscopy within the next couple of weeks for the first time since dx'd with OSA. I had my first & only surgery 13 years ago, and it took 5 hours for me to come out of recovery!!! I clearly remember over the last several hours of recovery, that I would go for what seemed several solid minutes without breathing, and that it felt weirdly wonderful and peaceful--that I just was annoyed and apathetic about the nurse coming around periodically to yell "BREATHE!!!" at me. As I look back on it since knowing I have OSA, this whole thing seems startlingly scary to me now. It was never addressed with me by the surgeon or PCP.

I have no intention of having this procedure done without sedation, having gone through it once before in 2000. It was very uncomfortable a couple of times for a few moments, even with the sedation.
I will be eagerly reading all comments and thoughts here.

km,

Grace, peace, and love to you. You will be in my thoughts and prayers. When I have this procedure done, they do not put me under; but the do give me valium or some other "don't care" shot.

amos

I had mine about 8 months ago. The sedation was of the "twilight" variety, which is common for outpatient procedures. They can talk to you and you can answer simple questions ("Do you cheat on your wife any more?"), but you generally have no memory of it.

The famous Michael Jackson drug propofol, mixed with other sedatives in a cocktail, is commonly used to put patients on the very edge of unconsciousness. The good news is that once they stop pumping it into a vein, the patient recovers very quickly. Important for an outpatient procedure.

If I had any OSA problems, I am not aware of it.

I'm pretty sure it's a colonoscopy not a sigmoidoscopy. i've never had either before --i just know my body's reactions to sedation, drugs etc and that's what makes me scared. It is in a clinic setting, however from what i'm understanding it's set up like a mini surgical center for the post sedation care. after the proceedure they wheel you back to a "room" where you're hooked up to monitors etc until you pass critera then are discharged.

JimIllinois wrote:I had mine about 8 months ago. The sedation was of the "twilight" variety, which is common for outpatient procedures. They can talk to you and you can answer simple questions ("Do you cheat on your wife any more?"), but you generally have no memory of it.

The famous Michael Jackson drug propofol, mixed with other sedatives in a cocktail, is commonly used to put patients on the very edge of unconsciousness. The good news is that once they stop pumping it into a vein, the patient recovers very quickly. Important for an outpatient procedure.

If I had any OSA problems, I am not aware of it.

Did you bring your machine or is it necessary??

karessamom wrote:Ok, --i guess i need just a little encouragement.

It's all a matter of perspective.
I had a full colonoscopy a couple of months before
my OSA diag. Local sedation.....
here comes the good stuff.
No problem.

A few weeks ago I had to have a cystoscopy w/ no sedation .
I'll let you do the research.
I'll take the colonoscopy anyday, sedation or not.

karessamom -

No, I did not bring the machine, since I was told I would not really be asleep. I was in and out of the procedure area in less than a half hour, and fully cognizant as I was wheeled out to the recovery area. I don't remember most of the procedure itself (thankfully). I did get 5 nice digital photos taken by the scope, to share with my friends.

The place was a colonoscopy factory - people filing in, people filing out. I hope they wash the scope between procedures...

The evening before is far more scary, trust me.

Ach! I'm a veteran of these colonoscopies having had Crohn's for better than 30 years. Actually, I PREFER my colonoscopies w/o sedation. I like to watch the monitor and see for myself. How uncomfortable it gets depends on your pain tolerance but moreso on the skill of your doctor doing the scope AND how much of a hurry he/she is in.

My gastro and I went round for round for a couple of years whether I would agree to a colonoscopy as she insisted on sedation and I insisted I did NOT want sedation. I went into my first colonoscopy under the impression there would be no sedation. The nurses weren't buying it and we had quite a bit of a "discussion" before they finally went and got the gastro because I got off the table and told them I was cancelling the procedure. We started w/o sedation, just demerol for analgesia. It was a bit uncomfortable at the sigmoid, but only uncomfortable. It got a bit uncomfortable again at the splenic flexure but again only uncomfortable. Unfortunately, woman have a longer transverse colon than men (and I swear more flexible as well!!!) and about 1/2 to 3/4 way thru the transverse colon almost to the hepatic flexure it got a bit painful. At this time the damn nurse was driving me nuts, ruining my concentration, trying to talk me into sedation. Like a fool, I finally said, "Okay, just a little, I want to watch". I felt a sting at the IV and then NOTHING!

Ha! I got even w/the witch! She hit me w/a full bolus of Versed and I flipped out, got agitated, got hostile, threatened to kill them all!!! It took 3 nurses to hold me down, my husband could hear me threatening them all the way down to the family waiting room. The scope was incomplete, of course. My gastro w/drew it as quickly as she safely could whilst the nurses were trying to keep me still. To this day when I see that nurse the hair on the back of my neck raises and I want to walk up and smack her along side her head. I volunteered at this hospital for 9 years so I had plenty of instances where I really had to control my temper when I ran into her in the hallway!!!!

Don't let this scare you. I've had Versed once since then, but given properly and titrated slowly as it should have been done.

Anyway, my gastro FINALLY actually underwent both an upper endoscopy and a colonoscopy w/o sedation herself. She agrees w/the me, the upper endoscopy w/o sedation is worse due to the unavoidable gagging. I had refused any further colonoscopies and then finally sent her a couple of articles about colonoscopy w/o sedation before she did so.

We now do my colonoscopies w/o sedation which is nothing but an amnesiac. You feel everything but don't remember it depending on how much sedation they elect to give you. I have NO DISCOMFORT w/just demeral until the transverse colon, we always have "fun" at that point, but its just discomfort, not pain.

ONE time, I did agree to Propofol (diprivan) for sedation for a colonoscopy when my Crohn's was flaring and I was hurting from the disease itself. IF you don't mind not being able to watch the monitor or remember the procedure, propofol is GREAT!!! You are clear-headed, alert and aware, ALMOST instantly after they stop the drip. None of this still so drugged you don't remember the gastro coming in after the procedure to talk to you and going home and sleeping some more.

But, I still prefer no sedation and watching the monitor. What I do HATE and dread about the colonoscopy is the darn prep. Gag. All that bilge water to drink in such a short amount of time! Blech! Honest injun, the prep is the WORST PART of a colonoscopy. Its a piece of cake after that.

The thing about propofol (diprivan) is that there is no reversable agent for it. So most states require that only anesthesiologists can administer it. Which means in those states it is usually only used for colonoscopies in hospitals. Or fully equipped outpatient surgical facilities.

Which takes me back on subject: sedation for colonoscopy and OSA. Take your xPAP w/you. And a family member who knows how to set it up, put your mask on you and turn it on. You are at little to no risk during the procedure since you are constantly monitored. BUT - the same can't be said for when you are taken back to the recovery room. THAT is when your family INSIST on being w/you and on putting your xPAP on you. My experience has always been, in 3 different facilities, that immediately after the procedure you are wheeled to an individual recovery room and your family is brought in to be with you. The nurses check on you occasionally. They may or may not leave 02 on you for a while. The 02 is just via a nasal cannula. There is a small plastic adapter you can get from your local DME supplier (because most hospitals and facilities won't have one) that goes on your xPAP between humidifier and hose and has a nipple for the 02 line to be attached.

Endoscopy 2002 Jun;34(6):435-40

Patient pain during colonoscopy: an analysis using real-time magnetic endoscope imaging.

Shah SG, Brooker JC, Thapar C, Williams CB, Saunders BP.
Wolfson Unit for Endoscopy, St. Mark's Hospital, Harrow, London, United Kingdom.

BACKGROUND AND STUDY AIMS: Colonoscopy is generally perceived as being a painful procedure. Contributory factors are: stretching of the colonic wall and mesenteric attachments from looping of the instrument shaft, overinsufflation, the degree of torque or force applied to the colonoscope shaft, and patient pain threshold. The aim of this study was to determine the frequency of pain episodes experienced during diagnostic colonoscopy and the corresponding colonoscope configuration, utilizing real-time magnetic endoscope imaging (MEI).

PATIENTS AND METHODS: Consecutive outpatients undergoing colonoscopy were studied. Patients with previous colonic resections were excluded. Procedures were commenced with antispasmodics only, and patient sedation was self-administered whenever significant discomfort was experienced, using a patient-controlled analgesia (PCA) syringe pump. All "demands" were correlated with the MEI record, which was subsequently analysed.

RESULTS: A total of 650 demands were recorded in 102 patients. Seventy-seven percent of all demands occurred with the colonoscope tip in the sigmoid colon, 7 % in the descending colon, 6 % at the splenic flexure, 5 % in the transverse colon, and 4 % in the proximal colon. Ninety percent of all pain episodes coincided with either looping (79 %) or straightening of the colonoscope shaft (11 %); presumed overinsufflation being an infrequent cause of pain (9 %). Of the loops encountered during colonoscopy, the N-sigmoid spiral loop was associated with the majority of pain episodes (56 %). Looping was both more frequent ( P = 0.0002) and less well tolerated in women than in men ( P = 0.0140).

CONCLUSIONS: This study is the first to document pain at colonoscopy accurately. Looping, particularly in the variable anatomy of the sigmoid colon, is the major cause of pain, especially in women. Use of MEI may improve pain control by facilitating the straightening of loops within the sigmoid colon, and by enabling the endoscopist to target patient analgesia.

PMID: 12048623 [PubMed - indexed for MEDLINE]

Gastrointest Endosc 1996 Feb;43(2 Pt 1):124-6

Why is colonoscopy more difficult in women?

Saunders BP, Fukumoto M, Halligan S, Jobling C, Moussa ME, Bartram CI, Williams CB.
Department of Endoscopy, St. Mark's Hospital, London, England.

BACKGROUND: In our experience colonoscopy in women is more difficult than in men. A retrospective review of 2194 colonoscopies performed by a single experienced endoscopist (CBW) showed that 31% of examinations in women were considered technically difficult compared with 16% in men.

METHODS: To investigate a possible anatomic basis for this finding, normal barium enema series from 183 female and 162 male patients were identified. From these barium enemas, measurements of colonic length and mobility were independently taken by two physicians who were unaware of each patient's gender.

RESULTS: Total colonic length was greater in women (median, 155 cm) compared to men (median, 145 cm), p = 0.005, despite women's smaller stature (p < 0.0001). Although there were no significant differences in rectum plus sigmoid, descending, or ascending plus cecum segmental lengths, women had longer transverse colons (female median length, 48 cm; male median length, 40 cm), p < 0.0001. There were no differences in mobility of the descending colon and transverse colon between the sexes, but the transverse colon reached the true pelvis more often in women (62%) than in men (26%), p < 0.001.

CONCLUSIONS: Colonoscopy appears to be a technically more difficult procedure in women. The reason for this may be due in part to an inherently longer colon.

PMID: 8635705 [PubMed - indexed for MEDLINE]

I had a colonoscopy in May of this year. Mine was the twilight type of sedation where you're not fully "out." I remember watching it on the screen, and hearing them talk, and the doc actually talked to me a little bit, and then said at the end everything looked perfect. I figure I was probably awake off and on. No pain, just minor discomfort every now and then. And I'm a big baby when it comes to pain during procedures. This was nothing. They wheeled me back across the room where they gave me a soda and some crackers. I stayed in there until the doc came in and gave me the results, and soon after the nurse said I could get dressed and leave. (Obviously had someone there to drive, as you're not supposed to drive after it due to the sedative not having fully worn off.) Not a long time at all. No cpap needed. I took a friend to have hers done a few years ago. She had the twilight type sedation and doesn't remember a thing.

Thanks everyone Slinky thank you especially--you always have such great info.

Buy some gatoraide and popcicles, for the night before. I believe green or yellow colored is ok, they don't want ya to have red colored. Chicken broth is ok also. Welcome to the club, soon you will be a perfect a$$hole

I'm in Slinky's club, having been diagnosed with Crohn's in 1975. Back then, they did colonoscopies with no sedation, no pain meds, no nuttin'. (At least in the UK, where I lived at the time.) Eventually they started using Versed and Valium on me, as I don't tolerate Demerol at all. After I had eight surgeries in 2004-5, though, the Versed/Valium cocktail no longer worked, nor did morphine. (According to my doc, my body built up a tolerance to these meds. Prior to this, just a whiff would knock me out.) So... for my last colonoscopy (also an upper endoscopy), they used Propofol.

Way back when, I used to look down the scope. Over the years as my disease progressed, I'd seen enough of my innards and went for the meds, as the pain was worse. Having been awake for upper endoscopies in the past, I'd *never* want to be awake for one again. Propofol is the best, IMNSHO, as you're almost instantly awake once they stop the drip. They had me on O2 via nasal cannula, and I was fine, though I was closely monitored due to severe asthma. (This latest procedure was a couple months before my OSA diagnosis.)

BTW, apparently there's a connection between breast and colon cancer. My mom survived breast cancer in her early 60s, only to succumb to a very fast moving colon cancer at 79. (She'd had a clear colonoscopy just three months prior to getting sick!) Regardless of your family history of breast cancer, colon cancer is very curable if they catch it early. Best to have the colonoscopy! And as Slinky says, it's the prep that's by far the worst. I generally eat very lightly for a few days ahead of time, then do the clear liquids before the actual prep. That way there's not a lot for my body to get rid of, and I don't have to do all the prep. I can never get more than half down (if I expect to keep it there, that is).

Anyway, good luck. Unless you're curious about what your guts look like, go for the Propofol.

I had a colonoscopy 5 years ago...before I knew i had sleep apnea. It was no big deal. after they explained to me that i would be semi-conscious and could watch the whole thing on video if i wanted....they asked if i had any questions. i asked if they could knock me completely out. and they did. i don't remember any of it. perfect.

you wake up pretty quickly...so i don't know that i'd worry a lot about OSA. might mention it to the doc, though.

if you have a choice...take the pills instead of the goo you have to drink to cleanse before the procedure. more agreeable!